anemias Flashcards
what is Hb level considered to be anemia for menstruating adults, pregnant adults, and male adults
menstruating: Hb < 12
pregnant: Hb < 11
male: < 13
average size of RBCs
used to classify anemia as either microcytic, normocytic, or macrocytic, each with its own
differential diagnoses
MCV (mean cell volume)
the weight of hemoglobin per red blood cell
MCH (mean corpuscular hemoglobin)
indicates the amount of
hemoglobin per unit volume
MCHC (mean corpuscular hemoglobin concentration)
assess production of new RBCs
- The “corrected” version takes into account the Hgb level and assesses whether the reticulocytosis is adequate for the severity of anemia
- CRC: reticulocyte % x (Hgb/15)
CRC (corrected reticulocyte count)
reflects variation in RBC size and is expressed as a percentage
- Seen on peripheral smear
RDW (Red cell distribution width)
a protein that stores iron
- Low levels can indicate iron deficiency
- High levels can indicate iron overload
serum ferritin
iron transporter protein
Serum transferrin
in iron-deficient conditions, the relative transferrin content compared to iron content increases, and thus, the TIBC values are high (there are open spots that could bind iron but no iron to
bind there)
TIBC (total iron binding capacity)
the % of iron binding sites on transferrin that are occupied by iron
- Low saturation means low iron
Transferrin saturation
Premature destruction of RBC’s
- Hemoglobin breakdown products retained in blood
- Increased circulating reticulocytes due to increase in erythropoiesis—a
compensation mechanism**
- Increase in serum LDH (abundant in RBC’s)
- Increase in indirect bilirubin -> Jaundice*
- Direct bilirubin may also begin to accumulate -> dark urine
- Decrease in haptoglobin -> bound by free Hb and depleted
- Most are:
- Normocytic*
- Normochromic
hemolytic anemia
- Destruction of RBCs by antibodies that target RBC antigens
- Clinical signs: typical for anemia, typical for hemolysis
Autoimmune hemolytic anemia
how to make diagnosis for autoimmune hemolytic anemia
ID of appropriate Ab by DAT (Coombs test)
autoimmune hemolytic anemia treatment (depends on severity)
- Reduction of anemia
- Prevention of complications like blood clots
- X linked deficiency of enzyme need to maintain RBCs
- Clinical signs of hemolytic anemia in neonate
- Triggered by medications, infections, fava beans
- Clinical signs of hemolysis
G6PD deficiency
how is G6PD diagnosis made
- hemolysis
- G6PD activity
- genetic testing
G6PD treatment
- avoiding triggers
- treating anemia as needed
Clinical signs for anemia, plus more specific symptoms:
including pica, restless legs, atrophic gastritis, and angular cheilosis
Microcytic anemia
Assess iron status with: serum ferritin, serum iron, TIBC
Supporting labs:
* Decrease in MCV (< 80 fL)
* Increase in TIBC (> 68 mmol/L)
* Increase in % of hypochromic RBCs (> 6%)
* Decrease in CRC (< 29 pg)
iron deficiency anemia
what is important to remember to do with iron deficiency anemia
must determine reason for iron deficiency
r/o possible bleeding somewhere
iron deficiency anemia treatment
dietary changes, oral supplements, IV iron
- Variants: X linked, recessive, toxic exposures, neoplasm
- Bone marrow forms ringed sideroblasts instead of healthy
erythrocytes - From abnormal iron use the heme isn’t formed properly
- Can cause micro or macrocytic anemia, but usually microcytic
- Normal to high iron levels
sideroblastic anemia
(can be a result of lead poisoning?)
how to diagnose sideroblastic anemia
ringed sideroblasts from bone marrow—stain with Prussian blue stain
- Chronic inflammation causes iron sequestration and failure of heme
synthesis - Chronic renal failure
- Often normocytic early on then may become microcytic as it
progresses - no rise in erythrocyte production in response to anemia
- decreased Hgb, relic count, iron, and TIBC*
Anemia of chronic disease
how to treat anemia of chronic disease
Treatment of anemia and underlying etiology as needed
